Objective: To investigate the mediating role of children s sleep quality in the association between mother-child relationship and the executive function of preschool children, providing a reference for promoting the development of the executive function of preschool children. Methods: A stratified cluster sampling method was used to select 842 preschoolers from 12 kindergartens in Wuhu City, Anhui Province in December 2021 as the subjects of the first follow up study with follow up every six months thereafter. Finally, 746 children were included in the study after 3 follow up. Spearman correlation analysis was used to explore the associations among mother-child relationship, sleep quality and executive function in preschool children. Bootstrap program and PROCESS software were applied to test the mediating effect of sleep quality in the association between mother-child relationship and the executive function of preschool children. Results: Conflictual mother-child relationship was positively correlated with the total score of executive function, as well as scores of inhibitory, shifting, emotional control, working memory, and organizational planning ( r=0.40, 0.37, 0.36, 0.41, 0.38 , 0.34, all P <0.05). Dependent mother-child relationship was positively correlated with the total score of executive function, as well as scores of inhibitory, shifting, emotional control, working memory , and organizational planning ( r=0.23, 0.20, 0.21, 0.22 , 0.22, 0.19, all P <0.05). Sleep quality was positively correlated with the total executive function score ( r=0.27, P <0.01). After adjusting for confounding factors, sleep quality played a partial mediating role in the associations between dependent and conflictual mother-child relationships and executive function, the mediating effects were 19.40% and 11.22% respectively. Conclusions Sleep quality plays a mediating role in the association between mother-child relationship and the executive function of preschool children. Improving sleep quality in the early stage can promote the executive function of preschool children.

Objective:To explore the effects of high-efficiency centering pregnancy care (CPC) combined with information-knowledge-attitude-practice (IKAP) health education on cesarean delivery on maternal request (CDMR) rate, maternal and neonatal health status so as to provide referential significance for reducing CDMR rate and improving postpartum maternal and neonatal health status and breastfeeding rate.Methods:In the prospective, single-center and controlled study, a total of 82 primiparas undergoing antenatal examination and delivery in South Binhu Hospital of Hefei First People′s Hospital were enrolled as the research objects between January 2020 and December 2021 by convenience sampling method, including 41 cases given routine health care in routine group between January and December 2020 and 41 cases given high-efficiency CPC combined with IKAP health education on basis of routine group in combination group between January and December 2021. The cognition of cesarean section, delivery modes, incidence of postpartum complications, neonatal complications and breastfeeding between the two groups were compared.Results:The age of the routine group was (26.71 ± 2.18) years old, and the age of the combination group was (27.16 ± 1.79) years old. The proportions of correct cognition, partially correct cognition and incorrect cognition to cesarean section in combination group were 73.17% (30/41), 21.95% (9/41), 4.88% (2/41), and 53.66% (22/41), 26.83% (11/41), 19.51% (8/41) in routine group, and the difference between the two groups was statistically significant ( Z = 4.22, P<0.05). The incidence of cesarean section and CDMR in combination group was 24.39% (10/41) and 1/10, lower than that in routine group [46.34% (19/41), 10/19], and the difference between the two groups was statistically significant ( χ2 = 4.32, P<0.05; Fisher′s exact test, P = 0.049 ). The total incidence rates of postpartum complications of primiparas and neonatal complications in the combination group were 4.88%(2/41) and 7.32%(3/41), lower than 12.20%(5/41) and 12.20%(5/41) in the routine group, and the differences between the two groups were not statistically significant (Fisher′s exact test, P = 0.432, 0.712). The scores of functional health literacy, communicative health literacy and critical health literacy in combination group were (85.73 ± 4.09), (51.93 ± 4.72) and (58.63 ± 4.32) points, higher than those in routine group [(80.17 ± 5.26), (46.37 ± 5.11) , (52.71 ± 5.07) points], and the difference between the two groups was statistically significant ( t = 5.34, 5.12, 5.69, all P<0.01). At 3 months after delivery, exclusive breastfeeding rate, milk powder feeding rate and mixed feeding rate in combination group were 58.54% (24/41), 7.32%(3/41), 34.15(14/41), higher than 26.83% (11/41), 29.27(12/41), 43.90%(18/41) in routine group, and the difference between the two groups was statistically significant ( χ2 = 10.73, P<0.05). Conclusions:High-efficiency CPC combined with IKAP health education can reduce incidence of CDMR, decrease maternal and neonatal complications, enhance maternal postpartum health literacy and improve breastfeeding rate in primiparas by improving correct cognition to cesarean section. It is worthy of clinical application.

Objective To evaluate the clinical efficacy of plasma exchange(PE)and double plasma molecular absorption system(DPMAS)in the treatment of primary biliary cholangitis(PBC)and the effect of this therapy on prognosis.Methods The clinical data on 526 PBC patients in our hospital from December 2013 to January 2022 were retrospectively analyzed.The patients were divided into different groups according to different therapies and then matched with propensity.The changes in symptoms,laboratory indexes and MELD scores were compared between two groups before and after treatment,and the clinical efficacy of artificial liver treatment for PBC patients was assessed.The effect of this treatment on the survival outcomes in these patients via comparing the cumulative survival rates at 3,6 and 12 months between the two groups.Results The efficiency was better in the group with artificial liver treatment in addition medical therapy than the group with medical treatment alone,the difference was statistically significant(76.7%vs.55.8%,χ2 = 4.214,and P = 0.040).Cox proportional risk regression showed that TBIL was an independent risk factor affecting the 3-,6-,or 12-month survival in PBC patients.Conclusions Artificial liver support system can effectively relieve symptoms,reduce levels of ALT,AST and TBIL,improve blood coagula-tion function,and lower MELD scores in PBC patients.This therapy revealed a trend of improvement in 3-,6-,or 12-month survival outcomes.

Objective: To explore the mediating role of psychological and physical aggression in the association between maternal emotional symptoms with emotional and behavioral problems in preschool children, so as to provide references for effective intervention of risk factors related to childrens emotional and behavioral problems. Methods: A longitudinal study was conducted to select 12 kindergarten children and their mothers in Wuhu City, Anhui Province by using stratified clustering sampling. The baseline survey was carried out in June 2021, followed up every six months, and a total of 3 followups were administered. Totally 853 valid questionnaires of junior class children were included by the survey data from baseline, second and thirl followups. The Depression Anxiety and Stress Scale-21 (DASS-21), the Parent-Child Conflict Tactics Scales (CTSPC) and the Strength and Difficulties Questionnaire (SDQ) were used to measure maternal emotional symptoms, psychological and physical aggression, and childrens emotional and behavioral problems, respectively. Results: The physical aggression of mothers towards children in boys was higher than in girls (t=3.53, P<0.05). The results of correlation analysis showed that maternal depressive symptoms were positively correlated with psychological aggression, physical aggression and childrens SDQ scores (r=0.20, 0.21, 0.18, P<0.01), maternal anxiety symptoms were positively correlated with psychological aggression, physical aggression and childrens SDQ scores (r=0.24, 0.22, 0.10, P<0.01), respectively; maternal stress symptoms were positively correlated with psychological aggression, physical aggression. The SDQ scores were positively correlated (r=0.26, 0.25, 0.18, P<0.01), and the scores of maternal psychological aggression and physical aggression were positively correlated with the SDQ scores of children (r=0.12, 0.16, P<0.01). The mediating analysis showed that after controlling for related confounding factors, psychological aggression played a partial mediating effect in the association between maternal depressive symptoms and childrens emotional and behavioral problems, and the mediating effect ratio was 8.05%. Physical aggression played a partial mediating effect in the association between maternal depression, anxiety and stress symptoms and childrens emotional and behavioral problems, which were 15.94%, 11.73% and 12.54% (P<0.05), respectively. Conclusions Psychological and physical aggression play mediating roles in the association between maternal emotional symptoms and childrens emotional and behavioral problems, and actively improving maternal emotional symptoms and their childrens discipline methods can help reduce the occurrence of emotional and behavioral problems in preschool children.

Perimenopausal syndrome （MPS）， a common endocrine system disease， is one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in endocrinology， gynecology， and interdisciplinary fields of both Western and Chinese medicine to discuss the advantages and challenges of diagnosing and treating MPS with Western medicine， TCM， and integrative medicine. Experts at the conference believe that MPS is initiated by estrogen decline and rooted in deficiency， with the pathogenesis being imbalance between Yin and Yang in the kidney. The hormone replacement therapy in Western medicine for menopause can rapidly alleviate related symptoms by quickly restoring the estrogen level and timely detect and delay complications of menopause， whereas such a therapy has certain risks， necessitating close monitoring of adverse reactions. Moreover， the various contraindications and precautions limit the clinical application of the hormone replacement therapy. TCM has advantages in synergistically alleviating symptoms such as hot flashes， sweating， sleep disorders， and emotional abnormalities of MPS without causing obvious adverse reactions. However， its efficacy is slower than the hormone replacement therapy， and the TCM evidence for preventing and treating complications of menopause remains unclear. Three suggestions were proposed for the future development of both Western and TCM for ameliorating MPS. First， an integrated diagnosis and treatment system for MPS with both Western and Chinese medicine should be established. Second， high-quality evidence-based interventions for MPS should be developed with TCM alone or in combination with Western medicine. Third， efforts should be made to promote the new TCM drug development and the interdisciplinary cooperation for treating MPS.

Objective:To investigate the clinical characteristics and management status of children with Turner syndrome (TS) in China.Methods:As a cross-sectional study, 1 089 TS patients were included in the database of the National Collaborative Alliance for the Diagnosis and Treatment of Turner Syndrome from August 2019 to November 2023. Clinical characteristics (growth development, sexual development, organ anomalies, etc.), karyotypes, auxiliary examinations, and treatments were collected and analyzed.Results:Among the 1 089 TS cases, 809 were recorded karyotypes. The karyotype distribution was as follows: 45, X in 317 cases (39.2%), X chromosome structural variants (including partial deletions of p or q arm, ring chromosome, and marker chromosome) in 89 cases (11.0%), 45, X/46, XX mosaicism in 158 cases (19.5%), mosaicism with X chromosome structural variants in 209 cases (25.8%), and presence of Y chromosome material in 36 cases (4.4%). Among the 824 TS cases, the age of diagnosis was 9.7(6.4, 12.2) years, with a height standard deviation score (HtSDS) of -3.1±1.2. Five hundred and fifty three cases underwent growth hormone (GH) stimulation test, and 352 cases (63.7%) had GH peak values <10 μg/L and 75.9% (577/760) had low IGF1 levels, with IGF1 SDS ≤-2 accounting for 38.2% (290 cases). Among 471 cases aged ≥8 years, 132 cases (28.0%) showed spontaneous sexual development (mean bone age (11.0±1.7) years), 10 cases had spontaneous menarche (mean bone age (12.0±2.2) years), and 2 cases had regular menstrual cycles. Common physical features included cubitus valgus (311 cases (28.5%)), neck webbing (188 cases (17.2%)), low posterior hairline (185 cases (17.0%)), shield chest (153 cases (14.0%)), high arched palate (127 cases (11.6%)), short fourth metacarpal (43 cases (3.9%)), and spinal abnormalities (38 cases (3.5%)). Congenital cardiovascular and urogenital anomalies occurred in 91 cases (19.4%) and 66 cases (12.0%)respectively. Abdominal ultrasound in 33 cases (7.2%) indicated fatty liver, hepatomegaly, intrahepatic bile duct stones, and splenomegaly. Among 23 cases undergoing oral glucose tolerance test (OGTT) test, 2 were diagnosed with diabetes mellitus and 4 with impaired glucose tolerance. Following diagnosis, 669 cases (80.7%) received rhGH treatment at a chronological age of (9±4) years and bone age of (8.3±3.2) years. Additionally, 112 cases (19.4%) received sex hormone replacement therapy starting at the age of (14±4) years and bone age of (12.6±1.2) years.Conclusions:The karyotypes of 45, X and mosaicism were most common in Chinese children with TS. The clinical manifestations were mainly short stature and gonadal dysplasia. However, a few TS children could be in the normal range of height, and some cases among those aged of ≥8 years old had spontaneous sexual development. Some exhibited physical features, congenital cardiovascular and urogenital anomalies, and dysfunction of the hypothalamic-pituitary-IGF1 axis. Moreover, a few of them developed impaired glucose tolerance and diabetes mellitus. Following diagnosis, most of the patients received rhGH treatment, and a few of them received sex hormone replacement therapy.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

OBJECTIVE To explore the epidemiological characteristics,symptoms and CT features of fungal ball sinusitis.METHODS A retrospective analysis was conducted on the clinical data of 182 patients with pathologically confirmed fungal ball sinusitis,in which demographic characteristics,sinus involvement,and imaging manifestations were analyzed.RESULTS Unilateral maxillary sinus involvement was predominant(144 cases,79.1%).Head and facial pain(83 cases,45.6%)was the most common clinical symptom.In terms of CT imaging,the total incidence rate of calcification and bone hyperplasia is 93.4%(170/182);There was no statistically significant difference in the occurrence of bone hyperplasia between different sinuses caused by fungal infections(P>0.05).The probability of fungal maxillary sinusitis and fungal sphenoid sinusitis affecting the nasal septum is the same(P>0.05).The presence or absence of high-density shadows in CT imaging does not increase the probability of pathological detection of Aspergillus(P>0.05).CONCLUSION The probability of bone hyperplasia and accumulation of nasal septum bone in different sinuses infected with fungal balls is the same.

Rheumatoid arthritis(RA)is a clinically refractory autoimmune disease.The destruction of bone and articular cartilage is a key pathological feature in the middle and late stages of RA.Acid-sensing ion channel 1a(ASIC1a)is a member of extracellular H+activated cation channel family,which can transmit low pH signal from extracellular microenvironment into cells,activate downstream pathways and induce a series of pathological changes.New evidence shows that ASIC1a plays a key role in the pathogenesis of RA,promoting joint inflammation,synovial hyperplasia and the destruction of bone and articular cartilage,which is of great significance in the pathological process of disease.In this paper,the molecular characteristics of ASIC1a are briefly reviewed,and the possible mechanism of ASIC1a to improve cartilage injury of RA is emphasized,so as to provide new ideas for the treatment of RA.